Wednesday, July 06, 2005

This is regarding the patient with the persistent RML abnormality (part 1, part 2,) who came in with empyema and infected RML.After "cooling things down" with a few days of ABTx he improved and underwent a RMLobectomy: most of the RML was an inflamed cystic pus-filled space. In its very center was an adenocarcinoma (T2). Cytokeratin subtype immunostaining favors a primary lung adeno. The path on all the nodes revealed 1 positive node at a N1 station. All other nodes and all margins were tumor-free. He is being D/C'ed home on ABTx and will follow up with us and oncology to decide whether he wants adjuvant Tx for his stage IIB tumor.I will try and get some path pictures and post them at a later point.Have you been more aggressive at recommending adjuvant Tx for lower-stage disease?

Oh, don't get me wrong I think from a populational aspect it makes good sense. Even from an individual perspective it also makes sense: this disease has such a dismal prognosis altogether that any benefit is good. I guess I was just lamenting how even at the current best standard of care how limited the options are...